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1.
Clin Rheumatol ; 39(12): 3535-3541, 2020 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-33067772

RESUMO

The novel coronavirus disease (COVID-19) pandemic has significantly impacted the field of rheumatology, in both the delivery of clinical care and didactic education for our trainees. These changes have generated significant strain for program directors and clinical educators who have had to leverage technology and develop new systems to ensure continued trainee education and assessment. We aim to outline the impacts on formal education programs presented by these unprecedented disruptions, describe the development and deployment of online teaching, reflect on the challenges and opportunities for technology-enabled learning and use of social media for education, and give some international perspectives on impacts on postgraduate rheumatology training outside the USA. With the rapid dissolution of barriers in place during the pre-COVID-19 era, we have the opportunity to assess the efficacy of new methods of care and further integrate technology into teaching and assessment. We propose that a hybrid in-person and technology-enabled learning approach, so-called blended learning, is likely to remain the most desirable future model for supporting trainee learning.


Assuntos
Infecções por Coronavirus/epidemiologia , Educação a Distância/métodos , Educação de Pós-Graduação em Medicina/métodos , Pneumonia Viral/epidemiologia , Reumatologia/educação , Currículo , Humanos , Disseminação de Informação , Pandemias , Mídias Sociais
2.
Semin Arthritis Rheum ; 50(5): 1191-1201, 2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-32931985

RESUMO

INTRODUCTION: COVID-19 is an acute respiratory viral infection that threatens people worldwide, including people with rheumatic disease, although it remains unclear to what extent various antirheumatic disease therapies increase susceptibility to complications of viral respiratory infections. OBJECTIVE: The present study undertakes a scoping review of available evidence regarding the frequency and severity of acute respiratory viral adverse events related to antirheumatic disease therapies. METHODS: Online databases were used to identify, since database inception, studies reporting primary data on acute respiratory viral infections in patients utilizing antirheumatic disease therapies. Independent reviewer pairs charted data from eligible studies using a standardized data abstraction tool. RESULTS: A total of 180 studies were eligible for qualitative analysis. While acknowledging that the extant literature has a lack of specificity in reporting of acute viral infections or complications thereof, the data suggest that use of glucocorticoids, JAK inhibitors (especially high-dose), TNF inhibitors, and anti-IL-17 agents may be associated with an increased frequency of respiratory viral events. Available data suggest no increased frequency or risk of respiratory viral events with NSAIDs, hydroxychloroquine, sulfasalazine, methotrexate, azathioprine, mycophenolate mofetil, cyclophosphamide, or apremilast. One large cohort study demonstrated an association with leflunomide use and increased risk of acute viral respiratory events compared to non-use. CONCLUSION: This scoping review identified that some medication classes may confer increased risk of acute respiratory viral infections. However, definitive data are lacking and future studies should address this knowledge gap.


Assuntos
Antirreumáticos/farmacologia , Infecções por Coronavirus , Pandemias , Pneumonia Viral , Doenças Reumáticas , Betacoronavirus , Comorbidade , Infecções por Coronavirus/diagnóstico , Infecções por Coronavirus/epidemiologia , Humanos , Hospedeiro Imunocomprometido , Pneumonia Viral/diagnóstico , Pneumonia Viral/epidemiologia , Doenças Reumáticas/tratamento farmacológico , Doenças Reumáticas/epidemiologia , Medição de Risco , Índice de Gravidade de Doença
3.
Artigo em Inglês | MEDLINE | ID: mdl-32937027

RESUMO

Rheumatology fellowship recruitment in 2020 will be fully virtual. The authors discuss benefits and challenges to the 2020 Rheumatology Fellowship recruitment season, as well as offer suggestions to minimize disruptions and optimize the process for programs and applicants.

4.
Arthritis Rheumatol ; 2020 Aug 02.
Artigo em Inglês | MEDLINE | ID: mdl-32741139

RESUMO

OBJECTIVE: Antirheumatic disease therapies have been used to treat coronavirus disease 2019 (COVID-19) and its complications. We conducted a systematic review and meta-analysis to describe the current evidence. METHODS: A search of published and preprint databases in all languages was performed. Included studies described ≥1 relevant clinical outcome for ≥5 patients who were infected with severe acute respiratory syndrome coronavirus 2 and were treated with antirheumatic disease therapy between January 1, 2019 and May 29, 2020. Pairs of reviewers screened articles, extracted data, and assessed risk of bias. A meta-analysis of effect sizes using random-effects models was performed when possible. RESULTS: The search identified 3,935 articles, of which 45 were included (4 randomized controlled trials, 29 cohort studies, and 12 case series). All studies evaluated hospitalized patients, and 29 of the 45 studies had been published in a peer-reviewed journal. In a meta-analysis of 3 cohort studies with a low risk of bias, hydroxychloroquine use was not significantly associated with mortality (pooled hazard ratio [HR] 1.41 [95% confidence interval (95% CI) 0.83, 2.42]). In a meta-analysis of 2 cohort studies with some concerns/higher risk of bias, anakinra use was associated with lower mortality (pooled HR 0.25 [95% CI 0.12, 0.52]). Evidence was inconclusive with regard to other antirheumatic disease therapies, and the majority of other studies had a high risk of bias. CONCLUSION: In this systematic review and meta-analysis, hydroxychloroquine use was not associated with benefit or harm regarding COVID-19 mortality. The evidence supporting the effect of other antirheumatic disease therapies in COVID-19 is currently inconclusive.

5.
J Med Educ Curric Dev ; 7: 2382120520928996, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32577531

RESUMO

The Institute of Medicine states that most diagnostic errors are caused by flaws in clinician diagnostic thinking. Accurately inferring the correct diagnosis from the patient history is the best way to improve diagnostic accuracy and efficiency. Such an improvement is contingent upon training early phase medical learners how to organize data from a patient history to arrive at the most likely diagnosis of the patient's chief health concern (CC). We describe how organizing the traditional history of present illness into what our trainees have come to call the "All-Inclusive History of Present Illness" (AIHPI) by applying the Bayesian statistical concepts of chronologically sequencing, as suggested by Skeff, both relevant historical risks and known medical events generate a series of pre-event probabilities of the most likely disease causing a patient's CC. Our trainees have enthusiastically recognized that the AIHPI organization process helps them improve both their ability to deliver well-organized, succinct verbal case presentations and the efficiency of generating and communicating what they think is the most likely disease causing a patient's CC.

7.
Rheum Dis Clin North Am ; 45(1): 13-26, 2019 02.
Artigo em Inglês | MEDLINE | ID: mdl-30447742

RESUMO

The United States is facing a rheumatology provider shortage over the next decade, which will negatively affect care for patients with rheumatic disease across the nation if this deficit is not thoughtfully addressed. The increasing numbers of retiring rheumatology specialists, women entering the workforce, and rheumatology graduates seeking part-time employment were identified as the most significant factors driving the projected decline in supply of providers. The major factors driving the projected increase in demand include an aging and growing population and improved treatment options, both of which increase disease prevalence and the challenge of managing chronic rheumatologic diseases.


Assuntos
Mão de Obra em Saúde/tendências , Reumatologistas/provisão & distribução , Reumatologia/tendências , Acesso aos Serviços de Saúde , Necessidades e Demandas de Serviços de Saúde , Humanos , Admissão e Escalonamento de Pessoal , Médicas , Aposentadoria , Doenças Reumáticas/epidemiologia , Doenças Reumáticas/terapia
8.
J Nurs Adm ; 47(6): 313-319, 2017 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-28509721

RESUMO

BACKGROUND: The Centers for Medicare and Medicaid Services Innovation Center introduced the Bundled Payments for Care Improvement (BPCI) initiative in 2011 as 1 strategy to encourage healthcare organizations and clinicians to improve healthcare delivery for patients, both when they are in the hospital and after they are discharged. Mercy Health Saint Mary's, a large urban academic medical center, engaged in BPCI primarily with a group of medical diagnosis-related groups (DRGs). OBJECTIVES: In this article, we describe our experience creating a system of response for the diverse people and diagnoses that fall into the medical DRG bundles and specifically identify organizational factors for enabling successful implementation of bundled payments. RESULTS: Our experience suggests that interprofessional collaboration enabled program success. CONCLUSIONS: Although still in its early phases, observations from our program's strategies and tactics may provide potential insights for organizations considering engagement in the BPCI initiative.


Assuntos
Redução de Custos/economia , Assistência à Saúde/economia , Medicaid/economia , Medicare/economia , Pacotes de Assistência ao Paciente/economia , Melhoria de Qualidade/economia , Centros Médicos Acadêmicos/economia , Grupos Diagnósticos Relacionados , Hospitais Urbanos/economia , Humanos , Estados Unidos
9.
West J Emerg Med ; 18(2): 189-200, 2017 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-28210351

RESUMO

INTRODUCTION: High-need, high-cost (HNHC) patients can over-use acute care services, a pattern of behavior associated with many poor outcomes that disproportionately contributes to increased U.S. healthcare cost. Our objective was to reduce healthcare cost and improve outcomes by optimizing the system of care. We targeted HNHC patients and identified root causes of frequent healthcare utilization. We developed a cross-continuum intervention process and a succinct tool called a Complex Care Map (CCM)© that addresses fragmentation in the system and links providers to a comprehensive individualized analysis of the patient story and causes for frequent access to health services. METHODS: Using a pre-/post-test design in which each subject served as his/her own historical control, this quality improvement project focused on determining if the interdisciplinary intervention called CCM© had an impact on healthcare utilization and costs for HNHC patients. We conducted the analysis between November 2012 and December 2015 at Mercy Health Saint Mary's, a Midwestern urban hospital with greater than 80,000 annual emergency department (ED) visits. All referred patients with three or more hospital visits (ED or inpatient [IP]) in the 12 months prior to initiation of a CCM© (n=339) were included in the study. Individualized CCMs© were created and made available in the electronic medical record (EMR) to all healthcare providers. We compared utilization, cost, social, and healthcare access variables from the EMR and cost-accounting system for 12 months before and after CCMs© implementation. We used both descriptive and limited inferential statistics. RESULTS: ED mean visits decreased 43% (p<0.001), inpatient mean admissions decreased 44% (p<0.001), outpatient mean visits decreased 17% (p<0.001), computed tomography mean scans decreased 62% (p<0.001), and OBS/IP length of stay mean days decreased 41% (p<0.001). Gross charges decreased 45% (p<0.001), direct expenses decreased 47% (p<0.001), contribution margin improved by 11% (p=0.002), and operating margin improved by 73% (p<0.001). Patients with housing increased 14% (p<0.001), those with primary care increased 15% (p<0.001), and those with insurance increased 16% (p<0.001). CONCLUSION: Individualized CCMs© for a select group of patients are associated with decreased healthcare system overutilization and cost of care.


Assuntos
Assistência à Saúde/organização & administração , Serviço Hospitalar de Emergência/estatística & dados numéricos , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , Planejamento de Assistência ao Paciente/organização & administração , Garantia da Qualidade dos Cuidados de Saúde/organização & administração , Melhoria de Qualidade/organização & administração , Análise Custo-Benefício , Assistência à Saúde/economia , Eficiência Organizacional , Serviço Hospitalar de Emergência/economia , Serviço Hospitalar de Emergência/organização & administração , Feminino , Custos de Cuidados de Saúde , Hospitalização , Humanos , Masculino , Planejamento de Assistência ao Paciente/economia , Garantia da Qualidade dos Cuidados de Saúde/economia , Melhoria de Qualidade/economia , Encaminhamento e Consulta , Estados Unidos/epidemiologia
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